Impact of non-credible cognitive performance on multidisciplinary treatment outcomes in youth with persisting...

This study characterizes patterns of non-credible cognitive performance, clinical presentations and functional outcomes, and multidisciplinary treatment response in youth with persisting symptoms after concussion. A retrospective analysis of demographic data, injury factors, symptom ratings, and functional outcomes was conducted in 136 patients (8-20 years-old; 64% female) presenting for multidisciplinary concussion care. Concussion mechanisms included sports, motor vehicle accidents, recreational activities, falls, assaults, and other mechanisms. Findings revealed approximately one-fourth of youth demonstrated non-credible cognitive performance. Compared to youth with credible cognitive performance, youth with non-credible cognitive performance were more likely to have premorbid attention or learning problems, non-credible neurologic exam findings, and significantly poorer cognitive performance across all tests apart from word reading. While youth with non-credible cognitive performance endorsed significantly more symptoms than those with credible cognitive performance at initial presentation and throughout the course of multidisciplinary treatment, their symptoms improved at a similar rate compared to those with credible cognitive performance. Additionally, groups did not differ significantly in school absences or parent-reported quality of life, despite higher self-reported symptom burden in the non-credible group. These findings suggest that youth with persisting symptoms who demonstrate non-credible cognitive performance similarly benefit from standard multidisciplinary concussion care, though they may continue to report higher symptoms throughout treatment. Additionally, youth with non-credible cognitive performance may also display non-credible findings on other aspects of multidisciplinary evaluations, highlighting the need for further research into individualized care models.